Chiclero's ulcer: An unusual presentation of Leishmania tropica in Syria

Cutaneous leishmaniasis (CL) has been an endemic disease in Syria for decades. The first reports of CL from the Syrian city Aleppo date back to the 17(th) century. The recent crisis has further empowered the spread of this infection not only in Syria, but also in the neighboring countries. Here, we describe a case of a 67-year-old patient with a 6-month, nonhealing ulcerative lesion of the left auricle. It was initially diagnosed as either a squamous or a basal cell carcinoma. However, the biopsy revealed an unexpected finding of Leishmania amastigotes in the histiocytes. Consequently, CL of the auricle, chiclero's ulcer, was diagnosed. Polymerase chain reaction, in turn, revealed Leishmania tropica to be the causing factor; a rather rare one for chiclero's ulcer. The lesion completely resolved after a 3-week glucantime regimen, without any recurrence after an 8-month follow-up.